6 Stress Relieving Tips for Nurses 

6 Stress Relieving Tips for Nurses 

6 Stress Relieving Tips for Nurses 

Being a nurse is a stressful job, and it’s not even a joke! Knowing different kinds of stress-relieving tips can help nurses from all walks of life. 

Why are Nurses Stressed?

As a nurse, your life is extra busy most of the time. As a nurse, the most helpful way to combat stress is to understand what stresses you out. It is not always easy to identify stressors but we can help you narrow it down, here are the most common causes of stress for nurses:

Constant use of critical thinking  skills 

Being a nurse you are always critically thinking, either how medication can impact a patient or when a family member has a difficult question. it can be a mentally draining job. A nurse’s job is demanding, and you do not always have the time to check out even if you want to.

Work environment demands 

There will be constant pacing while working with doctors and other healthcare providers when you are at work. It is common to clash with coworkers and patients at times or have miscommunication, leading to pressure and stress. 

A 12+ hour job

Long shifts can be exhausting, and nurses often work insanely long shifts. Many nurses work 12+ hours a day any extra overtime leads to increased stress and a drain on energy.  So it is prevalent among nurses to be a little cranky after each shift as it can be physically, emotionally and mentally draining, especially on the night shift. 

An emotional job

When you look at it, a nurse’s job is to take care of the sick and dying. But while they are caring for sick people, they also take care of the families left worrying or grieving. It can put an emotional strain on nurses and also be stressful on their part. In addition to that, some families can be challenging to deal with. While nurses are empathetic, coping with demanding families adds pressure to their jobs. 

The Pandemic

We were not prepared for the pandemic, and among healthcare providers, nurses are the most affected. Their responsibilities did not only double but also folded twice. They deal with the increased workload a pandemic brings while also putting their health on the line. Some are even assigned to do a job they were not adequately trained for to meet the nursing demands. Because of this, saying a nurse is stressed is underrated. 

Helpful and Stress Relieving Tips You Can Apply

So, what can you do to release the stress you feel each time you are under pressure at work? Knowing different stress-relieving techniques can help nurses big time. Here are a few:

Find a nursing path that you love

Are you stuck in a nursing job that you don’t like? Or are you looking for an option to do something else? If you answered yes to either, it’s time to move on to a different path in nursing. Keep in mind that nursing is an ever-dynamic field, so there is always something to do. If you love traveling, become a travel nurse, and if you enjoyed your time in the Operating Room as a student nurse, pursue a career in OR nursing. Maybe you are done with acute care and want to settle down in an outpatient clinic. The options are endless. Just make sure that the path you selected is something you would like to do for the long haul. 

Remind yourself why you became a nurse

Earning a high salary is one of the benefits nursing brings, but is it all you want? When things get tough, ask yourself why you became a nurse. Is it because you love helping others? Was it a good route for financial security?? – Whatever your reasons are, going back to the reason why you became a nurse will shed light on your darkest hours. So, whenever you feel stressed, use that reason to get back on your feet!

Sweat it out!

Another good way to relieve stress is through exercise. Many nurses find themselves sweating their stress out in the gym more often these days, so why not do the same? If you don’t like the confines of the gym, you can always work out at home. You can follow exercise apps or YouTube videos and burn those calories of frustration! Not only will you feel good, but you will also feel energized again, improve your health, and be pumped for your next shift.

Eat Healthily

Since we are talking about exercise, you might as well include your diet. To stabilize your energy, pair your workout with a balanced meal. Your diet must consist of energy-giving foods to keep you on your feet all the time. Eating green leafy vegetables, fruits, juices, and superfoods like nuts, avocadoes, sardines, berries, etc., must be included in your daily meals. These will keep you healthy and help reduce the stress and anxiety that you may feel at work. 

Practice meditation and breathing exercises.

Besides doing your workout routines, you must also practice breathing exercises and meditation. When things get crazy, pause, meditate and be mindful of your breathing. You don’t have to bring a yoga mat! Breathing techniques can be done anywhere, even at work. So, plan out your day, and take time to meditate, and refocus. It will help you get through even the most toxic shifts! 

Don’t forget to take time off.

All work and no play make you a dull person. So, relax, take time off and socialize. As much as you want to sleep on your day-offs, set time to socialize with friends or family. It is always good to have an outlet and to be yourself without worrying about the next patient chart you need to update. You don’t have to work all the time, find balance, and learn to live a stress-free life as a nurse. 

Your takeaway

As a nurse, facing stressful situations at work is a given. It is part of the profession. It is why you must find ways to destress. Don’t let the daily chaos of nurse life ruin your determination to help others. Try and see how these stress-relieving tips for nurses can help you. 

 

EP 163: Tips To Help You Survive Floating as a Nurse

EP 163: Tips To Help You Survive Floating as a Nurse

Tips To Help You Survive Floating as a Nurse

Survive floating as a nurse? It’s possible! You may have heard the term “floating” from nurses one way or another. While this term seems new, it has been used by many nurses in the unit before. So what is it? 

The term floating is used for a registered nurse who fills the short-staffed unit. They are also sometimes called float pool nurses and can be seen working in any area of a health care facility.

A floating nurse is the “reassignment of staff from one nursing unit to another, based upon the patient census and acuities.” They are an essential part of the healthcare staff and help to ensure that all areas are adequately staffed. 

Hospitals consider this a positive solution for saving money through resource utilization. It continues to be a staffing practice in health care facilities throughout the country. If you happen to be a floating nurse, this episode is for you. 

Today we will talk about how to survive floating as a nurse. It’s another day in the office when you walk into your unit, and you look at the assignment sheet and discover you have been assigned to float to another department. How you respond to this news can make or break the assignment.

How to Survive Floating as a Nurse

Not every nurse needs to float but there are many hospital positions that you can enter that allow you to float. Most of the time, floating nurses pay well. It is also a good reason why many nurses join the float pool. It is even better if you are a travel nurse.

Floating is challenging to get used to. Sometimes, a little bit impossible. It is because many nurses are unfamiliar with how things work in different units. The new environment can also be overwhelming. But the good news is that many nurses thrive in this position, no matter where they are.

In some cases, nurses choose to float because they like the idea of helping out units that need nurses the most.

1. Remain Calm

Why are you taking me off my unit? The first thing when you realize you’re floating usually your mood changes but don’t feel like to world is ending. Positivity and confidence are the keys. Go to the floating unit with a positive attitude to be welcoming to the new unit.

It makes such a difference when you ground yourself in positivity. Knowing no matter what happens, this shift will end and I will provide great patient care. This attitude will also set the mood for how your shift will go.

A lot of times floating nurses face unfamiliarity. This unfamiliarity may result in losing their confidence. Don’t forget you studied for over 4 years + to get your degree. Being in the position you’re in today, or the number of years of experience you have under your belt.

Start that positive self-talk with yourself. Remember, as a nurse you know what you have to do to take care of your patients. You’re good enough to be in the position that you’re in. Keeping calm and gathering your thoughts before working can also help.

2. Ask questions/learn the unit preferences

The best way to figure out the unit protocols or fit in is by asking what they do and why. After the huddle, go introduce yourself to the charge nurse.  Tell her you’re floating from another floor. If possible, ask if she can show you around the important thing you need to know about the unit. 

Remember, don’t hesitate or be afraid to ask questions. You have the whole shift to do that. Ask as many questions as you can so you are familiar with how the unit works.

  • Where is the medication room?
  • Do you have access to the pyxis?
  • Where is the supply room?
  • Are there standard charting or orders for this unit?
  • Where is the equipment room?
  • Where is the nutrition room?

Unit Routines

  • There might be different standing orders or charting protocol
  • Rhythm strips, pt weights
  • Specific handoff reports?
  • Specific medications to be signed off?
  • Accuchecks in the morning, are you covering the insulin

3. Speak up

No one knows if you don’t know something or if you’re struggling. Like any relationship communication is key. If you’re having a busy shift because you spent a lot of time getting yourself familiar with the unit, speak up. Make your needs known, most of the time everyone is helpful. 

When floating from the ICU: you can’t do everything for every patient

  • This isn’t the ICU, you can’t do everything
  • Importance of time management
  • Give recommendations but ultimately its the physician’s call

This is All a Learning Experience

In the younger nursing days, we pray not to get floated. We still to this day prefer to work in our home unit, but we have a positive outlook when it comes down to floating. Being challenged is a good thing, new experiences are what creates growth. Don’t be stuck in your own bubble because you hinder your growth. 

You too can survive being a floating nurse, here’s what you need to know 👇

TIME STAMPS:

00:00 Intro
00:44 Plugs
01:55 Episode Introduction
03:41 Tip #1: Remain Calm
07:39 Tip #2: Ask Questions
09:13 Things to ask: Where is the medication and nutrition room?
11:03 Things to ask: Where are the supply room and the equipment room?
17:47 Tip #3: Speak up
22:44 Tip #4: This is All a Learning Experience
25:08 Shadowing other nurses to learn
27:34 Sometimes Floating is not always good times

EP 162: What’s In my Nurse Bag

EP 162: What’s In my Nurse Bag

What’s In my Nurse Bag?

What’s a nurse without their backpack? A lazy one, probably! But jokes aside, have you ever wondered what is inside a nurse’s bag? As a nurse, you have to be prepared all the time. Does this mean you have to pack your bag with nurse equipment? No, not really, but there are a few things you need to have in yours. 

In this episode, we will talk about the items that are in our nurse’s bags or backpacks. If you are a nursing student or new nurse, you are probably wondering what you will need in your work bag or backpack. Aside from your personal stuff, what are the things you bring with you? 

Items that are in our nurse backpacks: 

1. Stethoscope

This is one of the most important tools for the medical field. Nurses use this tool all the time to hear breath sounds, or heartbeats. It is also for nasogastric tube placement, equal breath sounds on intubation and the list goes on.

2. Writing items 

  • The 4-in-1 pen. Some nurses have a highlighter with them.
  • Penlight

We tend to always check pupils as part of our standard assessment. Some hospitals may provide flashlights in every room for your neuro checks.

3. Scissors and tape

Bandage scissors are for cutting dressings, bandages, and other things. Micropore tape is also essential. It should be available, for example, when your patient pulls his/her IV. If your whole unit is on isolation precautions then, there isn’t a need to carry your own tape.

4. Books

A handy reference guiding listening down common medicine, procedures, and conditions. Since we work in the ICU a reference book for critical care is what we like to carry. You’ll have patients you haven’t taken care of in a while. These could be patients on paralytics and you need to perform a train of four. This makes to look information up without panicking or needing to ask.

5. Nursing documents/folder

This includes report sheets that you use to take notes of patient care. While traveling nursing you may want to hold onto all documentation.

The nursing documents must be in a reliable folder. Place it in a folder where you can use it for writing on it while getting a report.

6. Liquids

Usually, we are fasting during our shift, so we ingest a lot of liquids. This includes water, tea, or coffee. Usually, nurses bring two beakers. One for water and the other with their personal choice liquid.

7. Lotion and Hand Sanitizer

As nurses, we wash our hands so it’s important to prevent your skin from going dry, especially in the wintertime. Having to sanitize while having cracked hands isn’t painless, burn baby burn. Sanitizers help nurses steer clear of germs, along with other contagious agents.

8. Hair mask/bandanna

This is something we started to include during the pandemic of 2020. Since we have beards, we use PAPR’s to get into isolation rooms, the bandanna protects your hair and keeps it clean.

9. Charger and electronic accessories

Nowadays we always have the need to connect to the internet. If you’re working the night shift you listen to podcasts while charting on headphones.

10. Eye drops

The hospital always has low humidity for infection prevention measures. So having dry eyes can be a common thing. If you wear contacts during work your eyes may tend to dry up even more often.

11. Chapsticks

No one likes chapped lips, chap up! Little humidity air causes chapped lips. Another common cause of chapped lips is habitual licking. Lips don’t contain oil glands like other parts of the skin.

12. Planner/Journal

When there are a few minutes of downtime, it’s always good to plan out your schedule. This can also include taking out a journal and writing your thoughts down.

13. Miscellaneous

These miscellaneous items are not really as important as the ones listed above. However, they might come in handy at certain times. So, it’s better to have them ready in our bags in case we need to use them:

  • Protective eyewear
  • Loose bags of tea
  • Tylenol or ibuprofen
  • Alcohol pads
  • Light jacket

What’s in your nurse bag? Click here to find out what’s in ours! 👇

TIME STAMPS:

00:00 Intro
00:51 Plugs
02:14 Episode Introduction
04:54 Item 1: Stethoscope
06:05 Item 2: Writing utensils
07:52 Item 3: Penlight
09:31 Item 4: Scissors and potentially tape
11:23 Item 5: Books
14:58 Item 6: Nursing documents/Folder
16:26 Item 7: Liquids
18:30 Item 8: Lotion and Hand Sanitizer
19:52 Item 9: Hair mask/bandanna
21:12 Item 10: Charger and electronic accessories
22:45 Item 11: Eye drops
24:12 Item 12: Chapstick
24:45 item 13: Planner/Journal
25:37 Miscellaneous
29:10 Wrapping up the episode

 

 

EP 161: The Basics Every Nurse Should Know

EP 161: The Basics Every Nurse Should Know

The Basics Every Nurse Should Know

There are three basics every nurse should know by heart. You must understand that being a nurse comes with significant responsibilities. It’s like being a superhero, but your powers are stripped off when you make a mistake! You can say goodbye to your career and beloved profession if that is the case. 

Because medical errors are common these days, you must know all the nursing basics. Knowing all the basic procedures, SOPs, etc., will save your patient and your license as a nurse. 

As a nurse, you have to perform your job to the best of your abilities. It will also help you if you can memorize all the nursing basics there is to know so you can also serve your patients better. 

Keep in mind that there are many work-related basics that every nurse should know. These are all essential in making your job more effective. Nursing is composed of many different units and fields, each requiring its level of competence. Here’s what you need to know:

Basics Every Nurse Should Know About

 

1. Medications

Not every nurse works in the ER or ICU.  But there are specific medications that are often shared amongst most if not all units. Over the course of your work, you will get used to your unit’s medications. Those are unit-specific, but there are also medications that you’ll be familiar with.

Some of these are emergency medications and are often used as a quick solution to acute issues. The meds we’d like to address are more for emergent use and used as problem solvers. Medications like levothyroxine or pancrelipase are essential. But those are more unit-based. These are usually given the next day. We want to focus on meds that can benefit nurses in stressful situations.

  • Pressors

Vasopressors are among the common medications you’ll see in the ER or ICU. But if you don’t work in these units, you might think you’ll never use them.

Before you call that rapid or even during a rapid there are things you can do. If the patient is hypotensive there are 2 major things you can do; give fluid and/or start levophed. For patients with low blood pressure, norepinephrine is a good backup med. Levophed, Levo, norepi, and norepinephrine all mean the same thing.

You don’t have to memorize all vasopressors. Remember only the basic medications used like levophed. It is usually the first line of meds used in emergencies.

  • Antihypertensives

There are many ways to lower blood pressure and many meds. The most common ones we’ve seen are Nicardipine, metoprolol, and hydralazine. Each works differently but has the same functional effect on lowering blood pressure. 

  • Beta-blockers like metoprolol tartrate (Lopressor) or metoprolol succinate

Metoprolol tartrate is also referred to as Lopressor. It’s different than succinate because Lopressor wors quicker but not as long. We use Lopressor to bring down a patient’s blood pressure quickly. Metoprolol succinate is a common med prescribed outside the hospital because it can be taken once or twice a day vs. 4-6 times.

Keep in mind that this is a beta-blocker, which lowers blood pressure and heart rate. You’ll need to find a delicate balance in the amount of med to give for that reason, you need blood pressure control, but you can only give them so much before you throw them into heart block and need to pace them.

  • Vasodilators like hydralazine

Hydralazine is one of the main antihypertensives used in heart failure. It is an interesting medication because it primarily affects the arteries causing decreased peripheral resistance; reduced blood pressure; and reflexively increased heart rate, stroke volume, and CO.

The main contraindication is coronary artery disease because increased cardiac output increases cardiac work and may provoke angina and myocardial ischemia or infarction.

  • Calcium channel blockers like nicardipine

Calcium channel blockers are medications used to lower blood pressure. They work by preventing calcium from entering the cells of the heart and arteries. 

It also causes the heart and arteries to squeeze vigorously (contract). By blocking calcium, calcium channel blockers allow blood vessels to relax and open.

Nicardipine is given intravenously. Sometimes, patients with a stroke get placed on it for strict blood pressure management. It is a titratable drug. 

  • Insulin

So many different insulins. You don’t have to remember the exact hourly effect or half-life, just the basics. Lantus or glargine is long-acting. You’ll give it once a day, twice tops. 

NPH: this is the insulin you will give with meals. Regular is usually used for coverage.

 

2. Report

Each unit is going to have its own specific things they like in the report. For example, a cardiac ICU nurse gets more information about the heart. In the report, they write about the cardiac index, output, and pulmonary artery pressures. 

Regardless of what unit you are in, you need to know the basic information that is standard for each report. If by chance you are new, floating, or a travel nurse, your report improves over time. But, you will always be in the clear if you know the core basics. These are:

  • Room, name, age, code status, and allergies
  • Past medical history, contact info
  • Admission day, why they came in, and events during hospital stay/shift.
  • Planned procedures, able to DC or transfer, patient plan.
  • Neuro: Mentation, commands, fever, activity, RASS
  • Card: HR/rhythm, BP, pulses, and meds
  • Resp: O2, trach/ET size, tubes, vent settings, ABG, and lung sounds
  • GI/GU: Drains/tubes (NG, PEG, ostomy, etc..), output, last BM, and diet
  • Skin
  • Lines
  • Drips and important meds
  • Labs

 

3. Emergency basics every nurse should know

Not all floor requires ACLS, but BLS is a standard in the hospital. You should also know what to do in certain situations. Even though you may not perform all tasks during an emergency, it is always a good thing that you know what to do. 

Having a basic understanding during an emergency situation is essential. It is also good to know some of the algorithms, so you have an understanding of what to do in case of emergencies. 

 

  • Assess your patient, what has changed? Are they hard to arouse? Breathing? Pulse? 
  • ACLS
  • Bradycardia protocol 
  • Tachycardia with pulse

To watch this full episode, click here 👇

TIME STAMPS:

00:00 Intro
00:48 Plugs
02:12 Episode Introduction
02:41 Nursing Basics: Medication
05:05 Medication: Pressors
07:58 Medication: Antihypertensives
09:35 Antihypertensives: Metoprolol Tartrate (Lopressor) or Metoprolol Succinate
11:06 Antihypertensives: Hydralazine
11:51 Antihypertensives: Nicardipine
16:55 Antihypertensives: Insulin
20:05 Nursing Basics: Report
21:54 Reporting Run Down
24:13 Reporting Tips
27:57 Nursing Basics: Emergency Situations
31:17 Emergency Situations: Adult Cardiac Arrest
34:32 Emergency Situations: Adult Bradycardia
36:03 Emergency Situations: Tachycardia with a pulse
38:37 Wrapping up the episode

EP 158: Ventilator Settings for Nurses

EP 158: Ventilator Settings for Nurses

Ventilator Settings for Nurses

In today’s episode, we will talk about ventilators and how they can help healthcare professionals treat patients. Not every nurse will have a patient on a ventilator or work directly with it, but most emergent situations require one. It is always good to at least know the basics of a ventilator, so as a nurse, you know how you can use it if a situation arises. 

Mechanical Ventilation

Mechanical ventilation is an invasive way to provide oxygen to someone who is unconscious or needs help breathing. This machine is usually seen around ICUs or hospice care settings.

A mechanical ventilator is a machine that assists with oxygenation and directly inflates and deflates the lungs. It is used in a variety of situations like surgery and emergencies. 

Ventilator settings are inputs on a machine that determines how much support the patient needs. When we program a ventilator to a specific setting, we account for two things: oxygenation and ventilation.

  • Ventilation is the process of inhaling and exhaling.
  • Oxygenation is the process of adding oxygen to the body [1].

When is Mechanical Ventilation Needed?

  • Respiratory failure
  • failure to oxygenate
  • Failure to ventilate
  • Airway protection
  • Concerning findings include:
    • Respiratory rate > 30/minute
    • Inability to maintain arterial oxygen saturation > 90% pH < 7.25
    • PaCO2 > 50 mm Hg (unless chronic and stable)

Respiratory Mechanics

The normal inspiration generates negative intrapleural pressure. In return, this creates a pressure gradient between the atmosphere and the alveoli that result in airflow. In mechanical ventilation, the pressure gradient results from increased (positive) pressure of the air source.

Peak airway pressure

  • The peak airway pressure is measured at the airway opening and is routinely displayed by mechanical ventilators.
  • It represents the total pressure needed to push a volume of gas into the lungs and is composed of pressures resulting from inspiratory flow resistance (resistive pressure).
  • The elastic recoil of the lung and chest wall (elastic pressure), and the alveolar pressure present at the beginning of the breath (positive end-expiratory pressure, PEEP)
  • Peak airway pressure = resistive pressure + elastic pressure + PEEP

Resistive pressure

  • Resistive pressure is the pressure from the circuit resistance and airflow. In the mechanically ventilated patient, resistance to airflow occurs in the ventilator circuit, the endotracheal tube, and, most importantly, the patient’s airways.

Elastic pressure

  • The pressure of the elastic recoil of the lungs and chest wall and the volume of gas delivered. For a given volume, elastic pressure is increased by increased lung stiffness (as in pulmonary fibrosis) or restricted excursion of the chest wall or diaphragm (eg, intense ascites or massive obesity). Because elastance is the inverse of compliance, high elastance is the same as low compliance.

End-expiratory pressure 

  • The end-expiratory pressure In the alveoli is normally the same as atmospheric pressure. However, when the alveoli fail to empty completely because of airway obstruction. It could be airflow limitation, or shortened expiratory time, end-expiratory pressure may be positive relative to the atmosphere. 
  • This pressure is called intrinsic PEEP or autoPEEP to differentiate it from externally applied (therapeutic) PEEP. It is created by adjusting the mechanical ventilator or by placing a tight-fitting mask. This mask applies positive pressure throughout the respiratory cycle.
    • The pressure is given in the expiratory phase to prevent the closure of the alveoli and allow increased time for O2 exchange.
    • Used in pts who haven’t responded to treatment and are requiring a high amount of FiO2.
    • PEEP will lower O2 requirements by recruiting more surface area.
    • Normal PEEP is approximately 5cmH20. Can be as high as 20cmH20.

Intrinsic PEEP (auto-PEEP) 

  • Intrinsic PEEP or auto-PEEP can be measured in the passive patient through an end-expiratory hold maneuver. Immediately before a breath, the expiratory port is closed for 2 seconds. Flow ceases, eliminating resistive pressure. Thus resulting pressure reflects alveolar pressure at the end of expiration (intrinsic PEEP). 
  • Accurate measurement depends on the patient being completely passive on the ventilator. It is unwarranted to use neuromuscular blockade. Solely for the purpose of measuring intrinsic PEEP. 
  • A non-quantitative method of identifying intrinsic PEEP is to inspect the expiratory flow tracing. Check if the expiratory flow continues until the next breath of the patient. If the patient’s chest fails to come to rest before the next breath, intrinsic PEEP is present. 
  • The consequences of elevated intrinsic PEEP are increased inspiratory work of breathing and decreased venous return. This may result in decreased cardiac output and hypotension.

Airway Management

  • Airway cuffs
    • An inflated cuff helps with holding the airway in place
    • Reduces tidal volume loss
    • Decreases chance of aspiration
    • If a patient can speak, makes a weird noise from the cuff, or loses tidal volume, the cuff most likely needs more air. 

Ventilator Settings and Modes

When you’re looking at the ventilator screen it can be a little overwhelming at first. There are a lot of numbers, letters, and words. It is important to also not change any of those settings if you are unsure about operating it [2]. 

Ventilator Settings

Tidal volume

The tidal volume is the amount of air moving in and out of the lungs. The average adult breathes about 7 milliliters per kilogram of body weight. For males, the average Vt is 500 ml and for females about 400 ml.

  • Minute ventilation
    • The amount of volume inhaled and exhaled over 60 seconds. The average range is between 4 and 6 liters.
    • VE can be increased by taking deeper breaths or increasing the respiratory rate.
  • Alveolar ventilation
    • VA is similar to VE but without including dead space. Dead space is the air that is not undergoing active gas exchange. 
    • VA can be increased by breathing harder.

When the volume is too high, there is a risk of overinflation. However, when the volume is too low, it allows atelectasis. 

Frequency (Rate)

Respiratory rate is the number of breaths per minute. The average amount of breaths a person takes is 16. The vent can be programmed to deliver x amount of breaths a minute. 

FiO2

The FiO2, or fraction of inspired oxygen, is the concentration of oxygen that is being inhaled by the patient. The FiO2 of room air is about 21%. It is good to know that when you use a flow rate of 1 as it increases the FiO2 to 24%. For every liter, after that, it increases FiO2 by 4%. 

  • For patients with severe hypoxemia, a FiO2 of 100% may be required when mechanical ventilation is initiated. But your goal should be to wean the FiO2 down to the lowest possible level. That way, it provides adequate oxygenation. If a patient receives a FiO2 > 60% for a prolonged period of time, it increases their chances of oxygen toxicity.

Flow Rate

The inspiratory flow rate is a rate that controls how fast a tidal volume is then delivered. The ventilator setting can also adjust depending on the patient’s inspiratory demands
 
The normal inspiratory flow rate should be set at around 60 L/min. With that said, most ventilators can deliver up to 120 L/min if a patient needs a prolonged expiratory time. This is necessary when obstructive diseases are present.
  • If the flow rate is set too low, it could result in patient-ventilator dyssynchrony and an increased work of breathing. 
  • If the flow rate is set too high, it could result in decreased mean airway pressures.

I:E Ratio

The I:E ratio refers to a ratio of the inspiratory portion compared to the expiratory portion of the breathing cycle.

  • For patients on the ventilator, the normal I:E ratio is between 1:2 and 1:4. A larger I:E ratio may be delivered if a patient is in need of a longer expiratory time. It could be due to the possibility of air trapping.
  • The I:E ratio can be adjusted by making changes to the flow rate, inspiratory time, expiratory time, tidal volume, and frequency settings. 

Sensitivity

The sensitivity control determines how much effort (negative pressure) the patient must generate. This sensitivity can trigger a breath from the machine.
 
A normal sensitivity setting should be set between -1 and -2 cmH2O. If the sensitivity is set too high, it will cause the ventilator to start auto-triggering.
 
In return, it will increase the total frequency of breaths. If it’s set too low, the patient could have a difficult time initiating a breath.

Differences between PEEP, Pip, Pplat, and Alarms

PEEP

​​PEEP is a positive pressure delivered during the expiratory phase of the breathing cycle. It delivers breathing to prevent the closure of alveoli. It also allows increased time for oxygen exchange to occur.
 
It’s indicated for patients with refractory hypoxemia, and those who have not responded well to a high FiO2.

Peak Insp. Pressure (Pip)

Pip is the maximum pressure during inspiration. The goal is to have it under 35, with the goal of preventing lung injury. 

Plateau Pressure (Pplat)

Pplat measures lung compliance. This is measured at the end of inspiration with a hold, the goal is to have it under <30. 

Alarms

A ventilator alarm is a safety mechanism on a mechanical ventilator. It uses set parameters to provide alerts whenever there is a potential problem. This problem could be related to the patient-ventilator interaction.

  • High Pressure
  • Low Pressure
  • Low Expired Volume
  • High Frequency
  • Apnea
  • High PEEP
  • Low PEEP

Primary Control and Modes

In mechanical ventilation, there are two primary control variables [3]:

1. Volume Control

Volume Control means that you can set (or control) the patient’s tidal volume.
 
So with a set tidal volume and a set respiratory rate, this means that there is minute ventilation. This is good when it comes to making adjustments to achieve the desired PaCO2.
  • The cons of using Volume Control are, that the tidal volume is preset, and a patient’s lung is weak. It can result in high peak pressures.
  • Another drawback of Volume Control is patient-ventilator dyssynchrony.

2. Pressure Control

Pressure Control means that you can set (or control) the patient’s pressure to achieve a desired tidal volume.
 
As with Volume Control, a Pressure-Controlled tidal volume and set rate can help you reach the desired PaCO2.
 
  • The main disadvantage of using pressure control is the patient’s tidal volume. It can be unstable if there are changes in the patient’s lung compliance or airway resistance.
 
Volume Control and Pressure Control — are the two control variables. When initiating mechanical ventilation on a patient. Once you select the control variable, you can now choose the actual operational mode. It will determine the pattern of breathing for the patient.
 
Assist/Control (A/C) Mode
In this mode, the smallest number of preset mandatory breaths is delivered by the ventilator. However, the patient can also trigger assisted breaths. The patient makes an effort to breathe and the ventilator assists in delivering it. 
 
With that said, this mode of ventilation does not allow the patient to take spontaneous breaths. In this mode, the operator can set either a controlled pressure or a controlled volume.
 
  • The sensitivity control can also be adjusted to make it easier or harder for the patient to start a breath.

When to use a Ventilator

This mode is most often used when mechanical ventilation is first initiated for a patient. It provides full ventilatory support for the patient.
  • One of the advantages of using Assist/Control is that it keeps the patient’s breathing needs very low.
One of the major complications of Assist/Control is hyperventilation. This complication results in respiratory alkalosis. It is also the result when the patient has too many breaths. This is whether patient-triggered or machine-triggered.

Synchronous Intermittent Mandatory Ventilation (SIMV) Mode

In this mode, the ventilator delivers a preset small number of mandatory breaths. But, it also allows the patient to start spontaneous breaths between the mandatory breaths. This mode also allows the operator to set either a controlled pressure or a controlled volume

When to Use SIMV?

The primary sign of SIMV is when a patient needs partial ventilatory support. Since the patient can now take spontaneous breaths, they can also contribute to some of their minute ventilation. SIMV is a mode that is often used for weaning as well.

Advantages of Using SIMV

Because the patient can do spontaneous breaths, their respiratory muscle strength returned. It also helps the patient avoid muscular atrophy.
 
It distributes tidal volumes throughout the lung fields, which reduces V/Q mismatching. Besides that, it also helps to decrease the patient’s mean airway pressure.

To catch up on the full episode of Ep. 158, click here for more 👇

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00:00 Intro
00:45 Plugs
02:04 Podcast Introduction
04:19 When is Mechanical Ventilation Needed?
07:59 Respiratory Mechanics
10:14 Peak Airway Pressure
12:41 End-expiratory pressure
13:31 Intrinsic PEEP (auto-PEEP)
15:21 Air management Tips
17:42 Mode & Settings: Tidal Volume Mode
21:56 Mode & Settings: Frequency (Rate)
22:59 Mode & Settings: FiO2 – Fraction of Inspired Oxygen
26:27 Mode & Settings: Flow Rate
27:53 Mode & Settings: I:E Ratio
30:12 Mode & Settings: Sensitivity
32:27 Mode & Settings: PEEP
34:51 Primary Control and Modes: Volume Control
37:13 Primary Control and Modes: Pressure Control
38:23 Primary Control and Modes: Assist/Control (A/C) Mode
39:23 Primary Control and Modes: Synchronous Intermittent Mandatory Ventilation (SIMV)
42:56 Learn the basics
45:45 Dealing with ventilator alarms
46:28 Criteria for weaning off the ventilator
54:16 Wrapping up the episode